Q&A

“Literacy is a human right”: Exploring CVI and dual media literacy

Tammy Reisman, TVI, CAES, shares her core beliefs that all children can be readers, discusses the many aspects of a dual media literacy approach, and how she assesses and determines a path to literacy for her students with CVI

CVI Now hosted a live virtual event with Tammy Reisman, TVI, CEAS, to talk about CVI and literacy, specifically about a dual media literacy approach. Tammy has a strong background in the education of students with vision impairments and is highly skilled at comprehensively assessing and implementing a dual media approach for her students. She believes every student is a reader and a writer—the pathway will just look different. It’s important to offer multiple tools and options that build a fully accessible pathway to learning. Tammy is also the program coordinator for the Vision Studies program at UMass-Boston and teaches three courses in the program. UMass Boston is the first TVI program that included a mandatory semester-long course about CVI and the only institution that has a CVI graduate certification program.

Feel free to watch the video of our conversation and/or read the in-depth Q&A below. For providers in the field, learn more about how you can earn professional development credits.

You repeatedly say that every child with CVI can be a reader, writer, and problem solver. No child is too anything to keep them from being able to learn.

I feel very strongly that literacy is a human right. It’s critical to make sure that we teach our children with visual impairments, including CVI, in the best way they can learn—there’s always a way to reach them. I feel that it’s up to us as educators to figure out how to teach literacy skills to kids, regardless of their additional disabilities or complex needs or what else might be going on. Usually, a lot of that is done in collaboration. Teachers of the Visually Impaired (TVIs) should be working with other team members, such as general education teachers, literacy specialists, and other providers. 

Literacy is a human right. It’s critical to make sure that we teach our children with visual impairments, including CVI, in the best way they can learn—there’s always a way to reach them.

What does literacy mean to you? 

When I think about literacy, I think about communication. I think about engagement with the environment and engagement with other people. Literacy is how we interact with the world around us. I think about self-esteem. When kids start to learn, not just literacy, but any skills, their self-esteem just soars. They believe they can do anything. Literacy also means kids seeing themselves as readers, no matter what level they’re at. If you’re teaching these skills and having these high expectations, students start to see themselves as readers no matter how and what they’re reading initially.

Literacy is equality. Literacy is access. Every child, every individual, everyone deserves equal access to literacy instruction. And it’s up to the whole school team to figure out the student’s path to literacy. 

What is universal literacy?

I think of universal literacy as similar to the Universal Design for Learning (UDL). You’re finding ways to reach all students of all abilities and differentiate their instruction around literacy and how to teach them. It’s never a one-size-fits-all approach. You don’t just hear of one strategy or one method and say: Okay, you have this disability, or you have that diagnosis, this is how you need to learn. It’s figuring out what is the right way for that individual student. Sometimes, it could be a few different methods all at once. 

I think of one student who came to me years ago. She has a significant seizure disorder and a significant visual impairment due to CVI. She was having trouble seeing standard prints, anything that was two-dimensional, and needed everything three-dimensional. The more I assessed her and got to know her, the more we realized that she needed a tactile approach to learning. And at that time, standard braille just wasn’t working for the student. So we just started with tactile symbols, and every tactile symbol would be a specific vocabulary word. Then things started clicking, and she connected the braille words with the tactile symbols. From there, something started happening visually. She started connecting the print words with both the braille and the tactile symbols. She was reading in many forms. It was a slow process, and it didn’t happen overnight. But it happened. 

I saw how learning tactile media and building tactile skills did something to activate her visual system. It just all clicked. The brain is highly connected and our sensory systems are highly connected. Using tactile and auditory learning was a bridge to perception and understanding for this student. She was in a safe environment, and she realized that she was learning to read and literacy was coming to her. When she looked at items, she didn’t believe what she thought she was seeing was accurate. She just did trust her visual brain. And then she became more self-confident. She took risks. And she said as she was moving between tactile and visual media, “Well, if that says mom, does that say mom?” As she became more confident, her questions turned into statements. Multiple forms of learning media enabled her to verify what she was looking at. The belief in herself as a learner and a reader is powerful. 

I saw how tactile learning media and building tactile skills did something to activate her visual system. Using tactile and auditory learning was a bridge to perception and understanding… The belief in herself as a learner and a reader is powerful.

What is functional literacy? How has this meaning evolved?

Traditionally in special education for children with complex needs, functional literacy meant adjusted and lower expectations for literacy—teaching them how to read recipes, a label, signs in the community, their name, and maybe their family members’ names. For many years, it’s been a problem where we don’t have those high expectations that kids with different complex needs can learn. 

Now the field of special education is trying to get away from that old functional literacy mindset, and now we’re thinking more of it as just access to all media. That’s what functional literacy is—having that access and thinking about how all learners need literacy to engage in all activities in every environment. It could be reading those community signs, seeing the numbers in an elevator, but it’s also accessing something on the computer or even using their listening skills to access something that’s happening around them in a particular situation. That’s all a part of literacy media. 

We see all of these reading readiness checklists everywhere. How do we know when our kids with CVI are ready for literacy?

This goes back to my core beliefs. There shouldn’t be readiness checklists—all kids are ready for literacy right from the get-go, regardless of any disabilities they might have. Even if they aren’t ready to start with what you might call a conventional literacy program, they should be exposed to all forms of literacy. They should be exposed to teaching how all kids are being taught, even kids who have more complex needs. All kids should be a part of a reading group. They should be exposed to higher-level thinking and some of the higher-level books that are out there. Time and time again, I see kids in high school who are still reading Sesame Street books, for example. That’s great if that’s what the student likes. But they also need exposure to grade-level books. Every single book out there can be modified and adapted to meet the needs of individuals. 

Every single book out there can be modified and adapted to meet the needs of individuals. 

What is a dual media approach to literacy?

All learners are dual media learners, regardless of visual impairment status. Think about all of us as readers. We read standard print. We listen to things on a computer. We listen to things on the radio. We might listen to someone read something out loud. 

So all learners are dual media learners, and it looks different for individual kids. Some kids might be learning print, but they might need braille. Some kids might access things more auditorily, but they still might be using print to access some work or need braille to go along with it. Some kids, depending on their fine motor skills or any motor skills, may do more with tactile symbols initially, before they actually get to some of that standard print or braille. 

Dual media is using different media to teach kids in different ways.

Boy leans close to his smart brailler as he creates the letter b

How do we assess and determine the appropriate learning media and path to literacy?

It’s a lot of observation, and it’s the Learning Media Assessment (LMA). I believe in the learning media assessment because it helps us drive decisions in the programming for kids and their media decisions. 

You want to observe the students in as many different environments as possible. It’s not something that you could do in 30 minutes and say, “Okay, I know the kid.” It’s looking at every environment and what makes sense for them, including quiet and busier environments. And it’s critical to talk to families. What are they doing at home, and what’s important to the family? For some families, it’s important for them to have their kids learn some print in some way. And some might want their child to learn multiple forms of reading media, braille or listening skills. It’s a lot of observation. Kids with CVI have strategies for everything. 

I use multiple assessments when evaluating my students with CVI. It depends on the student. They’re all so individual. Especially with CVI, there’s such diversity. I want the best and most comprehensive information from an evaluation. I use the standard Learning Media Assessment by Keonig and Holbrook with some updated modifications. I use Texas School for the Blind’s Essential Tools of the Trade: A “How To” Guide for Completing Functional Vision, Learning Media and ECC Evaluations. This guide does an excellent job of bringing together functional vision and learning media assessments and offers some things to consider for CVI. I also use the TeachCVI tools, Roman-Lantzy’s CVI Range, and Dutton’s CVI Inventory. I especially like Matt Tietjen’s 2D Image Assessment and his Complexity Framework. I appreciate the 2D Image Assessment so much that I don’t only use it with my students with CVI but many of my other students with ocular visual impairments. Our students need a whole suite of assessment tools.

I look at how kids see things in their environment what behaviors they’re showing me visually. I look at how they explore items in their environment: Are they doing it more tactically or visually? Are they using a combination of all three senses? Or is it mostly two senses? Sometimes it’s cut and dry in terms of what they need. But most of the time, I need to experiment and try different things with kids. This means I’ll stick with something for a few weeks to see if it’s working or not. Sometimes it’s working, something else might need to be added, or sometimes I need to change what I’m thinking. 

Many individuals with CVI use compensatory skills for learning and accessing their environment. How do you find these when you observe your students? 

Observing is a skill. It takes practice. You have to know CVI and visual impairment. You have to understand what compensatory skills can look like across a wide range of students. Sometimes you miss things, so you go back, observe, and figure out what this student needs to be successful.

I recently evaluated a new student who has a new diagnosis of CVI. As I observed him do some work, I noticed that he was struggling to do this writing task. He looked like he was looking, but he wasn’t looking. When he was writing with a pencil, he felt the motion with his hand. He seemed to be using motor memory. So I asked him to tell me what he was doing, and he said he was trying to write his name. Then I said, “tell me what you’re seeing on the paper right now.” He said, “I don’t see anything.” I asked, “What are you trying to write?” He said, “I’m trying to write my name, and I’m trying to write the sentences that the teacher wanted me to write.” I asked him what his favorite color was, and he said it was orange. So I made an orange box on the paper and asked him to tell me what he sees. He said, “I see an orange box.” I then asked him to write his name in that orange box, which he did quickly. Then I said, “Now, tell me how you think I could help you to write these few sentences?” He asked for the orange box. I then had him switch to writing with a bold colored pencil, which made a huge difference. So what I’m finding—I’m not going to generalize here–but there have been a few kids that I’ve worked with that do better with color versus black and white for both reading and writing. 

Observing is a skill. It takes practice. You have to know CVI and visual impairment. You have to understand what compensatory skills can look like across a wide range of students. Sometimes you miss things, so you go back, observe, and figure out what this student needs to be successful.

Why is it so important to explore CVI and compensatory skills?

I firmly believe that using compensatory skills never takes away from using vision or developing visual skills. Compensatory skill use can enhance vision use. I’ve seen this in every single student I have worked with. It’s building the agency and letting them have choices. 

I go back to that one student who started with tactile symbols and is now reading print. After 10 minutes of reading, her eyes get exhausted, so she goes back to her tactile skills. But, she never gives up; she still wants to look at things and read print. But she knows that if she gets tired, she can go to her braille, go to her tactile symbols, or just listen if she just needs to relax everything completely. 

Kids without disabilities have many choices for accessing their learning and their world. Our kids with CVI need those choices too, and they need to be able to make those choices in their own way. They are so much more empowered when they know when it works for them to use print and when they need to use another literacy media. It’s about full access to learning, always. None of this happens overnight, but it’s what we have to think about when serving kids with CVI.

One more thing. Some of our kids with CVI can’t communicate their needs and choices to us right away or in a conventional sense. Sometimes they might seem to shut down, or they might refuse something. Then we hear the label, “They’re so behavioral. They’re not that listening.” Behavior ALWAYS means communication. It’s up to us to figure out why they’re reacting that way? Or why did they do that? There’s always a reason.

I firmly believe that using compensatory skills never takes away from using vision or developing visual skills. Compensatory skill use can enhance vision use. I’ve seen this in every single student I have worked with. It’s building their agency and letting them have choices. 

Grace wears pink head phones while holding an e-reader

If audio is part of the student’s dual media literacy approach, what are the skills involved in learning how to use this media?

You have to start with thinking about the different types of audio—there’s the audio where you’re just listening, audio where you also have the text and it’s highlighting the words, and audio where you’re listening to picture books and you have the book in front of you. It’s what doesn’t overwhelm the individual student and what makes the most sense.

Sometimes audio can be a lot for the student at the beginning. Generally, start at a lower audio speed, so the student gets used to it. For some kids, even when you’re doing a read-aloud, it’s hard for them to sustain attention and listen. It’s essential to teach some of those active listening skills. Perhaps start with reading out loud a sentence and then having them talk about that sentence or make a connection to that sentence and expand upon that a little bit. Chunk the audio to build those recall and comprehension skills.

When I evaluate listening skills, I’m looking at how accurately the student hears things, whether they’re sustaining visual attention while sustaining audio attention, following verbal directions, or completing tasks just with verbal instruction.

Read about how audiobooks helped Grace become a voracious reader.

How do school teams know when to introduce another learning media in addition to print for a child with CVI? 

First, there should be constant progress monitoring and data collection to see how the student is progressing and how they are accessing their learning. The Learning Media Assessment (LMA) should be used on an ongoing basis (both informally and formally) to ensure that what’s in place is working. The team might need to tweak or alter what’s in place based on this data. From there, the team may want to introduce another learning media when they aren’t seeing progress, when the student seems to be shutting down, or when there might be a change in how the student is responding to something. 

For families of students with CVI who read print, but it causes fatigue as they read more complex texts, how can both the student and family advocate for starting a path toward dual media literacy?

It doesn’t matter how old the child is; you’re never too old to learn another literacy media. Remember, the path to literacy is individual. When I see something that says braille is not appropriate or braille will never be appropriate for individuals with CVI, I don’t like that wording. I’d rather see something like Braille is not happening at this time, or it’s not being used at this time. As educators, we have to keep options open for our students; we don’t know what the future holds. It’s about the whole child. It’s about what will help the student in front of you find success. 

Parents can ask for a team meeting anytime. Request a learning media assessment and share your observations. If you’re noticing severe vision fatigue, noticing that they seem to be more tactual, or if there have been any changes from the ophthalmologist or optometrist reports, talk to your team. I know it’s hard. I know there are grave shortages of TVIs nationwide. So it’s hard. We’re working on recruiting and we’re trying to make it better. 

Learn more about the Vision Studies program at UMass Boston.

It doesn’t matter how old the child is; you’re never too old to learn another literacy media. Remember, the path to literacy is individual. It’s about what will help the student in front of you find success. 

What does it look like to teach both print and another literacy media?

We have to think about service delivery for students with CVI. Traditionally, those extensive service delivery hours were for students who were blind or low-vision academic kids learning braille. We need to reframe what service delivery looks like for all individuals on the blindness spectrum. 

It’s important to think about what makes sense for service delivery and not generalize and always put students with CVI in a consult box. I see a lot of kids with CVI who also have complex needs getting a monthly consult or weekly consult and no direct service, or maybe doing 30 minutes a week of tracking activities or that old-fashioned vision stimulation. One of the tools I like is the VISSIT from Texas School for the Blind. The VISSIT looks at all areas of the Expanded Core Curriculum (ECC), how important it is for the TVI to teach direct service for any of those areas, and then it helps you figure out the number of hours. It’s a good place to start. 

Once I determine both direct and indirect service hours, I tend to work with my students both inside and outside the classroom. When I’m in the classroom, I will go along with what’s happening with whole-class instruction. For example, I work with one of my elementary school students with CVI during reading and writing time in the classroom, and we’re doing some reading using print. He’ll get to a point where he’ll say, “I’m getting really tired, can we go into my quiet room?” and we’ll do some work there. I can see that he’s getting fatigued, so I’ll bring out the braille and do some braille activities. Then he’ll say, “Oh, this helped. Can I look now?” Kids are just amazing: They’re just so resilient and know what works for them.

It’s important to think about what makes sense for service delivery and not generalize and always put students with CVI in a consult box.

What does a dual media approach look like when making that jump from learning sight words and reading them in a sentence?

I’ll use one student as an example to show how I use a dual media approach to support learning sight words. I find what motivates him and what he loves. I create sight words from these high-interest activities and mix in sight words from the curriculum. I put them on cards in his most accessible print. Students also need to see these words grouped with other words—this is how we write, tell stories, and read stories. 

Literacy has to be meaningful. This student is learning both print and braille and loves learning tactually. I’ve created these books based on high-interest topics. I used the sights words “like,” “the,” “can,” and “is,” and I have simple sentences in the books that use those sight words. The student will open up the book and see a familiar photograph. He’s had a lot of real-world experience with what’s in the photo. There’s also a tactile symbol below the picture that represents what’s in the picture or a component of what’s in the picture. For example, there’s a picture of him looking toward the train tracks at a train station. The tactile will represent the train tracks. He often touches this tactile as he looks at the picture. We’ll talk about what the picture means, and he’ll tell me what he sees. 

Then he turns the page, and there are the 3-4 words with nothing else around it and some braille at the bottom of the page. There’s also space in between each word. An example of the sentence might be, “I like the train tracks.” We’ll read it together, and he’ll point to each word as he’s reading it. He knows the sentence connects with the picture that he just saw. Then he’ll turn the page, and there’ll be another picture and tactile symbol, and then we turn the page again, and there are some more words after that picture. 

Going from a word to a sentence without any other meaning around may be challenging for some kids. But if it’s within a book and a story that’s a high motivator, then I think that’s when they’ll start, at least for the student, when he began understanding the structure of sentences and reading sentences. These small books had more meaning for him than just trying to process single sentences.

When he’s reading the sentence in his book, I’ll ask him to show me the word train. And he’s scanning and looking at each word and accurately points to the word train. So he’s starting to learn to recognize words. He now sees himself as a reader and recognizes multiple forms of media as part of his reading journey. And now, when it’s independent reading time in his classroom, he’ll go and find one of his books and sit and read it for 15 minutes.

Black paper with a photo graph of the green line train in Boston with a green tactile stripe in an adapted book for CVI
Black paper with the words "You can go on the green line" written in blue on a white background in an adapted book for CVI
Black paper with photo of boy sitting on a bench and tactile strips to replicate feeling of bench in an adapted book for CVI
Adapted book for a student with CVI, black paper with the words "The bench" written in blue on a white background
Black paper with photos of a black car and a blue car with tactile circles to replicate headlights in an adapted book for CVI
Black paper with the words "You can go in a car" written in blue on a white background in an adapted book for CVI

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